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141. Transitions in Care | Digital Healthcare Research
     digital.ahrq.gov/health-care-theme/transitions-care
     January 01, 2023 - Transitions in Care Scalable Digital Communication Intervention to Support Older Adults and Care Partners Transitioning Home After Major Surgery Description This research will develop and evaluate the Perioperative Optimization of Senior Health (myPOSH) mobile application that…

142. Scalable Digital Communication Intervention to Support Older Adults and Care Partners Transitioning Home After Major Surgery | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/scalable-digital-communication-intervention-support-older-adults-and-care
     January 01, 2024 - Scalable Digital Communication Intervention to Support Older Adults and Care Partners Transitioning Home After Major Surgery Project Description Publications Creating a mobile application to support care transitions for older adults after surgery has the potential to prov…

143. Treating Comorbid Depression During Care Transitions with Relational Agents | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/treating-comorbid-depression-during-care-transitions-relational-agents
     January 01, 2023 - Treating Comorbid Depression During Care Transitions with Relational Agents Project Final Report ( PDF , 676.96 KB) Disclaimer Disclaimer The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily repres…

144. Strengthening Patient Engagement to Improve Care and Shared Decision Making - Emerging Research | Digital Healthcare Research
     digital.ahrq.gov/2020-year-review/research-summary/strengthening-patient-engagement-improve-care-and-shared-decision-making-emerging-research
     January 01, 2020 - Strengthening Patient Engagement to Improve Care and Shared Decision Making - Emerging Research Using Technology to Support Patient-Centered, Shared Decision Making in Care and Treatment Decisions Patient-centered shared decision making refers to the collaborative effort of a healthc…

145. Promoting Self-Management in Stroke Survivors Using Health Information Technology | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/promoting-self-management-stroke-survivors-using-health-it
     January 01, 2023 - Promoting Self-Management in Stroke Survivors Using Health Information Technology Project Final Report ( PDF , 180.67 KB) Disclaimer Disclaimer The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily …

146. An Automatic Notification System for Test Results Finalized After Discharge - 2012 | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/automatic-notification-system-test-results-finalized-after-discharge/annual-summary/2012
     January 01, 2012 - An Automatic Notification System for Test Results Finalized After Discharge - 2012 Project Name An Automatic Notification System for Test Results Finalized after Discharge Principal Investigator Dalal, Anuj K. Organization Brigham and Women's Hospital Funding Mechanis…

147. Improving Post-Hospital Medication Management of Older Adults with Health Information Technology - 2010 | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/improving-post-hospital-medication-management-older-adults-health-information/annual-summary/2010
     January 01, 2010 - Improving Post-Hospital Medication Management of Older Adults with Health Information Technology - 2010 Project Name Improving Post-Hospital Medication Management of Older Adults with Health Information Technology Principal Investigator Gurwitz, Jerry Organization University …

148. Secure Messaging | Digital Healthcare Research
     digital.ahrq.gov/technology/secure-messaging
     January 01, 2023 - Secure Messaging Health IT-Generated PROs to Improve Outcomes in Cirrhosis - Final Report Citation Bajaj J. Health IT-Generated PROs to Improve Outcomes in Cirrhosis – Final Report. (Prepared by Virginia Commonwealth University under Grant No. R01 HS025412). Rockville, MD: Age…

149. Virtual Patient Advocate to Reduce Ambulatory Adverse Drug Events (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/r18hs017196-jack-final-report-2011.pdf
     January 01, 2011 - pharmacist, who conducted the post-discharge reinforcement call in our prior studies of hospital readmission … Factors Predicting Readmission of Older General Medicine Patients. … The impact of patient socioeconomic status and other social factors on readmission: a prospective study

150. Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/citation/r03hs028033-frey-final-report-2024.pdf
     January 01, 2024 - Association between pediatric home management plan of care compliance and asthma readmission.

151. Dowding D et al. 2009 "Nurses' use of computerised clinical decision support systems: a case site analysis." | Digital Healthcare Research
     digital.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/research/dowding-d-et-al-2009
     January 01, 2009 - chronic obstructive pulmonary disease (COPD) who were living at home, with the aim of preventing their readmission

152. Development of a Clinical Decision Support Tool for Facilitating Naturalistic Decision-Making and Improving Blood Culture Utilization - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/citation/r21hs025238-xie-final-report-2020.pdf
     January 01, 2020 - PICU) and patient outcome (e.g., PICU length of stay, mortality rates, rates of hospital and PICU readmission … culture use and patient outcomes (e.g., PICU length of stay, mortality rates, rates of hospital and PICU readmission

153. E-Coaching: IVR-Enhanced Care Transition Support for Complex Patients - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/r18hs017786-ritchie-final-report-2012.pdf
     January 01, 2012 - follow-up and provision of educational materials) of the e-Coach intervention and likely influenced the readmission … readmitted during the first 7 days posthospitalization were excluded, the Hazard Ratio for hospital readmission

154. Information Needs of Homecare Nurses During Admission and Care Planning - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/citation/r01hs024537-sockolow-final-report-2020.pdf
     January 01, 2020 - care, or may not have the needed information to generate a high quality plan of care (POC) to prevent readmission … errors, and also alert nurses to patients likely to have issues with medications, a risk factor for readmission … Views of primary care physicians and home care nurses on the causes of readmission of older adults. … Impact of frontloading of skilled nursing visits on the incidence of 30-day hospital readmission. … Patient characteristics predicting readmission among individuals hospitalized for heart failure.

155. Electronic Health Record Use, Work Environments & Patient Outcomes - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/citation/r21hs023805-kutney-lee-final-report-2019.pdf
     January 01, 2019 - outcome variables were examined using the administrative patient data: inpatient mortality and 30-day readmission … dissatisfaction, and intention to leave) and two patient outcomes (surgical inpatient mortality and 30-day readmission

156. Quality Indicators Care Coordination Measures Project - 2010 | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/quality-indicators-care-coordination-measures-project/annual-summary/2010
     January 01, 2010 - Quality Indicators Care Coordination Measures Project - 2010 Project Name Quality Indicators Care Coordination Measures Project Principal Investigator Brustrom, Jennifer Organization Battelle Memorial Institute Contract Number 290-04-0020 Project Period Sept…

157. Medication Reconciliation | Digital Healthcare Research
     digital.ahrq.gov/medication-reconciliation
     January 01, 2023 - This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://digital.ahrq.gov/contact-us . Let us know th…

158. Using HIT to Improve Transitions of Complex Elderly Patients from SNF to Home - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/r18hs017817-field-final-report-2012.pdf
     January 01, 2012 - incidence of adverse drug events (ADEs) through 45 days following discharge, and the rate of hospital readmission … On the incidence of hospital readmission and emergency department (ED) visits within 30 days of discharge … The rate of hospital readmission and emergency department (ED) visits within 30 days of discharge

159. An Automatic Notification System for Test Results Finalized after Discharge | Digital Healthcare Research
     digital.ahrq.gov/ahrq-funded-projects/automatic-notification-system-test-results-finalized-after-discharge
     January 01, 2023 - An Automatic Notification System for Test Results Finalized after Discharge Project Final Report ( PDF , 195.47 KB) Disclaimer Disclaimer The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily repres…

160. Health Information Technology Evaluation Toolkit: 2009 Update (pdf file)
     digital.ahrq.gov/sites/default/files/docs/page/health-information-technology-evaluation-toolkit-2009-update.pdf
     January 01, 2009 - See the NRC’s Health IT Evaluation Measure Briefing Sheet: “Length of Stay” Readmission rates … collected by your facility’s quality assurance team Need to define the time period for the readmission … Need to consider reason for readmission and correlate it with a previous diagnosis – i.e., whether … ) Data Sou rce(s ) Notes Po ten tia l Ris ks Links Risk reduction measures • CMS fines for readmission … For example, in many cases a readmission may be the result of the natural history of a disease and